Consensus on the Diagnosis and Treatment of Adult Necrotizing Fasciitis (2025 Edition)
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摘要: 坏死性筋膜炎（NF）是一种罕见但极具侵袭性的软组织感染, 以筋膜和皮下组织的快速坏死为特征, 具有早期诊断困难、病情进展迅速的特点。若治疗不及时, 该疾病可迅速发展为全身性感染、脓毒症及多器官功能衰竭, 甚至导致患者死亡。目前, 我国尚未形成统一的NF诊治共识或指南, 临床诊治过程中仍面临诸多争议与挑战。为推动我国NF诊治的规范化进程, 中华医学会烧伤外科学分会、《中华烧伤与创面修复杂志》编辑委员会及中国医疗保健国际交流促进会烧伤医学分会组织相关领域专家, 依据国内外最新指南、文献及临床实践经验, 遵循循证医学原则, 经过反复讨论, 共同制订了《成人坏死性筋膜炎诊治专家共识（2025版）》, 旨在为NF的临床诊疗提供科学、规范的指导。Abstract: Necrotizing fasciitis (NF) is a rare but very aggressive soft tissue infection characterized by rapid necrosis of fascia and subcutaneous tissue, which is difficult to diagnose early and progresses rapidly. If not treated promptly, NF can quickly evolve into systemic infection, sepsis, and multiple organ failure, and even lead to the patient's death. Currently, there is not a unified consensus or guideline for the diagnosis and treatment of NF, and many controversies and challenges remain in clinical practice for its diagnosis and treatment. To promote the standardization of NF diagnosis and treatment, Chinese Burn Association, Editorial Committee of Chinese Journal of Burns and Wounds, and Burn Medicine Branch of China International Exchange and Promotion Association for Medical and Healthcare, have jointly developed the Consensus on the Diagnosis and Treatment of Adult Necrotizing Fasciitis (2025 Edition) based on the latest national and international guidelines, literature, and clinical practice experience, in accordance with the principles of evidence-based medicine, and through repeated discussion. This consensus aims to provide scientific and standardized guidance for clinical diagnosis and treatment of NF.
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Key words:
- Fasciitis, necrotizing /
- Diagnosis /
- Treatment /
- Multidisciplinary team /
- Expert consensus
本文亮点(1) 鉴于目前对于坏死性筋膜炎的诊断和治疗尚未形成统一规范，本共识依据国内外最新指南、文献及临床实践经验，遵循循证医学原则，通过多学科团队讨论制订。(2) 针对坏死性筋膜炎相关的多个临床问题提出推荐意见，有助于规范其诊断和治疗，同时为进一步完善其诊疗策略提供依据。 -
参考文献
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图 1 成人NF诊治简化流程图
注：NF指坏死性筋膜炎, LRINEC评分指坏死性筋膜炎实验室风险指标评分, SIARI指Site other than the lower limb, Immunosuppression, Age, Renal impairment and Inflammatory markers, LARINF指laboratory and anamnestic risk indicator for necrotizing fasciitis, CRP为C反应蛋白；“（-）”“（+）”分别表示阴性、阳性检查结果
Figure 1. Simplified flowchart for the diagnosis and management of adult NF
表 1 基于GRADE系统的坏死性筋膜炎推荐意见的推荐强度及证据等级描述
Table 1. The description of recommendation strength and evidence level of the GRADE system-based recommendations for necrotizing fasciitis
项目与分类 描述 推荐强度 强 强烈推荐采用 弱 结合临床审慎采用 证据等级 高 证据来源于基于创伤、坏死性筋膜炎人群良好设计的RCT, 或来源于包含至少1项高质量RCT的系统评价/荟萃分析、权威指南 中 证据来源于质量降低的RCT, 或来源于设计合理的非RCT、队列研究、病例对照研究、多中心的注册研究, 或来源于非创伤、坏死性筋膜炎人群的高质量RCT 低 证据来源于观察性研究, 或来源于非创伤、坏死性筋膜炎人群的非RCT、队列研究、病例对照研究等 极低 证据来源于个案报道、临床经验总结, 或来源于非创伤、坏死性筋膜炎人群的观察性研究 注：GRADE指推荐意见分级的评估、制订和评价, RCT指随机对照试验 
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表 2 坏死性筋膜炎实验室风险指标评分（分）
Table 2. Laboratory risk indicator score of necrotizing fasciitis
指标 C反应蛋白 白细胞计数 血红蛋白 血清钠 血肌酐 血糖 < 150 ≥150 < 15 15~25 > 25 > 135 110~135 < 110 ≥135 < 135 ≤141 > 141 ≤10 > 10 得分 0 4 0 1 2 0 1 2 0 2 0 2 0 1 注：该表内容来自参考文献[17]；C反应蛋白、白细胞计数、血红蛋白、血清钠、血肌酐、血糖的单位分别为mg/L、×109/L、g/L、mmol/L、μmol/L、mmol/L；患者的总得分≤5分为低风险, 发生坏死性筋膜炎的概率 < 50%；总得分6或7分为中度风险, 发生坏死性筋膜炎的概率为50%~75%；总得分≥8分为高风险, 发生坏死性筋膜炎的概率 > 75%
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表 3 坏死性筋膜炎的SIARI评分（分）
Table 3. SIARI score of necrotizing fasciitis
指标 分值 感染部位为非下肢 3 免疫缺陷史（获得性免疫缺陷综合征、化学治疗或使用激素） 3 年龄≤60岁 2 血肌酐 > 141 μmol/L 1 白细胞计数 > 25×109/L 1 C反应蛋白≥150 mg/L 1 注：SIARI指Site other than the lower limb, Immunosuppression, Age, Renal impairment and Inflammatory markers；该表内容来自参考文献[25]
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表 4 坏死性筋膜炎的LARINF评分（分）
Table 4. LARINF score of necrotizing fasciitis
指标 血红蛋白 降钙素原 C反应蛋白 心肝肾功能不全 免疫抑制 肥胖 > 135 g/L 110~135 g/L < 110 g/L < 1 ng/mL ≥1 ng/mL < 10 mg/dL ≥10 mg/dL 否 是 否 是 否 是 得分 0 1 2 0 3 0 1 0 2 0 2 0 1 注：LARINF指laboratory and anamnestic risk indicator for necrotizing fasciitis；该表内容来自参考文献[26]；1 dL=10 mL
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